1241: Ketamine | Skeptical Sunday

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Speaker 1 Welcome to Skeptical Sunday. I'm your host, Jordan Harbinger.
Today I'm here with Skeptical Sunday co-host, writer, and researcher Nick Pell.

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Speaker 1 Just visit jordanharbinger.com slash start or search for us in your Spotify app to get started. All right, now today, you might have seen ads for ketamine on social media.

Speaker 1 And if you're like me, you're thinking, isn't that a horse tranquilizer that raver kids used back in the 90s?

Speaker 1 And while that's true, ketamine is actually doing a lot of work helping people with depression, chronic pain, PTSD, and other ailments, both physical and psychological, that are resistant to other kinds of treatments.

Speaker 1 Not everyone with severe depression is going to respond to things like talk therapy or even medication, or even more extreme treatments like electroshock therapy, which, by the way, is real and still exists.

Speaker 1 You might have even seen the headlines like the mental health revolution or a cure in a syringe or tripping to heal. But what if it's not all that simple? Ketamine clinics are everywhere.

Speaker 1 You can get these treatments by mail, even, but anytime there's a big promise, we here at Skeptical Sunday, we get a little skeptical. So what does the science say?

Speaker 1 Here to help me dose the truth with minimal side effects is writer and researcher Nick Pell. Now, Nick, one of the reasons I had you do this is that you have done ketamine therapy yourself, correct?

Speaker 4 I did. It was multiple sessions over a period of a year, maybe a year and a half.

Speaker 1 Okay, so what for? Can I ask about that?

Speaker 4 I have a post-traumatic stress disorder of the shitty childhood variety, not the watched my best friend die in a rack variety. It's variously called called complex PTSD or childhood PTSD.

Speaker 4 Basically, I had classic combination of unstable mother and absent father, sort of understating it because lots of people have had it way worse than me, but how I had it was not super great.

Speaker 1 Yeah, you told me a bit about your childhood, not normal in a lot of ways.

Speaker 4 Yeah.

Speaker 4 My best friend from high school a couple of years ago told me, Man, every time you used to tell me some funny story about your house as a kid, I was always just like, that is so messed up, man.

Speaker 4 My wife has likewise asked that I stop sharing amusing anecdotes from my childhood because apparently they're not funny to anybody but me.

Speaker 1 Okay. Yeah.
Without dwelling too much on the specifics of your particular miserable childhood, walk us through your ketamine therapy experience.

Speaker 4 So towards the end of my first marriage, I was in pretty rough shape. I was sleeping maybe two hours a night.
I was waking up screaming all the time. I was having constant night terrors.

Speaker 4 I had a super short fuse. I would get just absolutely enraged over really trivial stuff.

Speaker 4 My former mother-in-law was actually the first person to point out that I had all of the classic symptoms of CPTSD.

Speaker 4 And so I looked into it and I talked it over with my therapist and decided that it was worth looking into ketamine therapy.

Speaker 1 Wow. So what was the process like? Do you just call them up and say like, hey guys, I think tripping my face off is the key to unlocking better mental health.
How does this begin?

Speaker 4 Kidding aside, it wasn't really all that different from that.

Speaker 4 i was pretty open about the fact that i used psychedelic drugs pretty heavily in the past and that they were helpful for my mental state huh okay so i can imagine what was their reaction to that they were just kind of like oh yeah we get you guys all the time yeah i can imagine they're probably pretty used to that honestly so What was the intake like?

Speaker 1 I mean, are they just letting anyone get the treatment or is there some due diligence on their part?

Speaker 4 I can only speak from my experience, but they were definitely thorough. They did a whole round round of blood work to see if my testosterone use was going to be an issue for the treatment.

Speaker 4 The whole intake process took a few weeks. They were definitely not just letting any dude come in off the street and get a ketamine treatment.

Speaker 1 Ah, okay. So it's good to hear that there was some kind of vetting involved.
Tell us about the actual treatment, though. What was that like?

Speaker 4 You go in, they take your vitals, you lay in a chair, they put an IV drip in your arm, and an hour later, you're like, where the hell am I? I ended one session and asked, am I in Arizona?

Speaker 1 Okay, so do they kind of ramp you up or how does it work with regard to the dosage? Are you just suddenly flying through space-time or like, what's it like?

Speaker 4 So when you first go in, you do it every day for a week. Then you come back a couple of weeks later.
Then they start stretching it out further.

Speaker 4 The goal is to get your dose right, but also to make it so that you're coming back less and less or at least further and further apart.

Speaker 1 When was the last time you went?

Speaker 4 It's been, I think, two and a half years.

Speaker 1 Oh, wow. Okay.
Why'd you stop going?

Speaker 4 So I feel like this is a good time to tell people that I genuinely don't understand why anyone uses ketamine recreationally. It's not fun.

Speaker 4 It's not awful, but the best I've ever felt on it was like vibing.

Speaker 1 Okay.

Speaker 4 I had my attendant hold my feet once because you don't even know that your body is there.

Speaker 1 Your attendant?

Speaker 4 Yeah, you get a little trip buddy to hang out with you the whole time. They're a medical professional.
They monitor your vitals.

Speaker 4 They had to give me blood pressure meds once in the middle of a session. Ketamine Ketamine is a really serious drug.
You can die. They can't just hook you up to an IV and leave you there.

Speaker 4 But yeah, I asked one of them to hold my feet because I was freaking out. And another time I cried for,

Speaker 4 I don't know how long, like a shirt was covered in tears. So I assume I was going at it for a long time.

Speaker 4 My attendant looked like she was really concerned about me, but you just, you have no sense of time.

Speaker 1 So I don't want to focus on my own experience here because I didn't do it for medical reasons, but I did do it with a doctor because I'm not crazy or maybe I'm crazy.

Speaker 1 I tried this with a doctor, not for depression or anything, just to, you know, me, I'm careful.

Speaker 4 YOLO

Speaker 4 tried it for YOLO.

Speaker 1 YOLO. And also like, I'm not going to recommend stuff that I haven't tried, even if it's a little out there.
So again, I'm not recommending it at all. I'm not qualified to do that.

Speaker 1 I do remember falling through the floor, falling through the earth, and it was not fun. It was like, you feel kind of sick.
I was like, am I going to die? She's like, no.

Speaker 1 And then when I was done, I was like, okay,

Speaker 1 that is medicine. That is not a thing you do for fun.
And I know I was going to joke that you're really selling it here, Nick, because it's like, it's not fun. I don't like it.

Speaker 1 It's not something I ever want to do again. It wasn't so terrifying.
I'm scarred from it. But people who drink because you lose your inhibitions and you have a fun night.

Speaker 1 And then the next day you're miserable. This is like, oh, the experience itself is miserable.

Speaker 1 And then if you have something that it cures or helps you with, like depression, then the benefits are later.

Speaker 1 But if you don't have that, you're just subjecting yourself to needless, frankly, psychological torture. So again, it's not something I recommend, frankly, for that reason.

Speaker 4 Yeah, it's not a party drug. It's a serious medical treatment.
Even when I was doing my own weight and mushrooms every week, the point was not really to party.

Speaker 4 I was trying to learn something about myself. And with the benefit of...
years of reflection, I think I was really trying to treat undiagnosed PTSD. And in this case, I wasn't snorting ketamine.

Speaker 4 I was getting an IV drips. It was very accurately measured for my specific body weight intolerance.
You know, I wasn't just blowing rails of it until I fell into a K-hole.

Speaker 1 Tell us what a K-hole is, by the way.

Speaker 4 I don't really know, man, because every time somebody describes a K-hole, I'm like, isn't this just what happens when you do ketamine? I guess it's like a profound sense of...

Speaker 4 It's not depersonalization. It's like almost like an out-of-body experience.
But yeah, like you don't know you have a body. You have no idea how much time is passing.

Speaker 4 You don't really know much to the point where it's, you don't even know that knowing things is a thing.

Speaker 1 I'm just realizing you said fell into a K-hole, and that's what they say. My experience was falling through the earth, falling through space, falling through time, falling through.

Speaker 1 So that must be pretty common, unless it's just a random coincidence that people say falling into a K-hole. It did feel like falling into an interdimensional, massive hole.

Speaker 1 That's exactly what it felt like.

Speaker 4 I didn't really feel like that. I know people say that, but that wasn't my experience.
Mine was just like, it's so difficult to quantify.

Speaker 4 Like anybody who's ever done any kind of psychedelic drug knows that people are like, what was it like? And you're just like, I can't tell you because this isn't really a thing I can put into words.

Speaker 4 But I would say that like extreme disassociation, that was the word I was looking for. You have an extreme sense of disassociation.
The The feet thing is a really good example.

Speaker 4 I needed somebody to hold my feet because it was freaking me out that I couldn't feel my body at all.

Speaker 1 Yeah, that makes sense. You're right about the psychedelic thing.

Speaker 1 On a Feedback Friday episode a few weeks ago or months ago, whatever it's been, I remember talking about my first mushroom experience in Amsterdam when I was like 19.

Speaker 1 And we took mushrooms and we were laying down. And I was like, to my friend Hans, I go, dude, I don't know what.
how to explain this, but like when the base goes, the vines come in.

Speaker 1 And when the base goes out, the the vines go away from me. And then I was like, I don't even know if that makes sense.
And he goes, dude, I know exactly what you mean.

Speaker 1 And we both started cracking up because it was like, of course, you don't really, but you do because we're both like, what planet are we on?

Speaker 1 And I remember telling him, he goes, why are you walking like that? And I said, because I'm like a penguin with a beach ball between my legs. And he was just like, oh, okay.

Speaker 1 Like that explanation makes total sense. Yeah, of course.
You're a penguin with a beach ball between your legs. And then when we sobered up, we were just like, what the hell was that?

Speaker 1 We're never doing that again.

Speaker 1 At least not until tomorrow.

Speaker 4 All right. So

Speaker 1 again, this is not medical advice, folks. These are stupid things we did as teenagers.

Speaker 4 Okay.

Speaker 1 But you haven't been back to ketamine therapy. Why? Because you don't need it.
And hopefully not because you can't afford it, but you still need it. What's going on here?

Speaker 4 Yeah. I don't feel like I need it.
The canary in the coal mine for my treatments was if my insomnia started acting up.

Speaker 4 I've had chronic insomnia since a very young age, just getting 15 to 20 hours of sleep a week. I don't have insomnia anymore.
I might get up for an hour, maybe, David, and that's really rare.

Speaker 4 I have nights where I have nightmares nonstop, but I just go back to sleep.

Speaker 1 Yep, that sounds awful, man. Geez.

Speaker 4 Nightmares are such a nothing burger for me at this point. It's just a night of restless sleep.
So yeah, if I ever get back to that point.

Speaker 1 So do you think the ketamine made a difference?

Speaker 4 I know there's a correlation. You have to fill out paperwork where you score how you feel on a number of metrics.
Some of it's objective, like hours of sleep, instances of suicidal ideation.

Speaker 4 Some of it is just how you feeling, man. I've made some changes to my life that helped keep things going.
I quit smoking pot. I have a much less volatile living situation.

Speaker 4 I think ketamine really helped kickstart a lot of that process, and that's really important.

Speaker 1 It's interesting, of course, but there's obviously more to ketamine therapy than Nick's personal story. I thought we'd start there, though, because we've talked about it in the past.

Speaker 1 I know you have a really balanced take on the use of ketamine as a therapeutic drug.

Speaker 4 Yeah, there's tons of men and women suffering for no reason who could get some serious long-term and potential life-changing relief.

Speaker 4 Ketamine has absolutely improved my life, but I don't see any need to continue treatment. And honestly, that's kind of the best thing I could say about it.
I never used antidepressants or anything.

Speaker 4 And people always ask me why. And because I didn't want to start taking drugs that I couldn't really stop taking.

Speaker 4 And you're right, there's a lot more to this than my personal story, but that's kind of it.

Speaker 1 Where does ketamine come from? Are there ketamine plants growing in the jungle or is it synthetic?

Speaker 4 So it's totally synthetic, actually. There aren't ketamine plants growing somewhere in the jungle.
It weirdly starts off in American medical practice as an alternative to PCP.

Speaker 1 So ketamine is essentially the supposedly safer alternative to PCP as angel dust, right?

Speaker 1 The stuff that makes people strip naked in a parking lot, get shot three times by the police and or someone else, and then run half a mile before they feel they collapse. That stuff?

Speaker 4 Yeah, I kind of laugh when I found this out about where ketamine comes from. All I could think of is that scene in Training Day where Denzel tricks Ethan Hawk into smoking Sherm.

Speaker 1 Is Sherm PCP? What is that?

Speaker 4 Yeah. Okay.

Speaker 1 You seem like the type of guy who will know why they call TCP Sherman Helmsley, baby.

Speaker 4 He was apparently fond of angel dust.

Speaker 1 Who is Sherman Helmsley?

Speaker 4 George Jefferson?

Speaker 1 Who's George Jefferson?

Speaker 4 Seriously, man, you don't know who George Jefferson is? I'm done with you here.

Speaker 1 Yeah, let's get moving on up to the history of ketamine then.

Speaker 4 So ketamine was first synthesized in 1962. It wasn't approved for use until 1970.
And then they use it as an anesthetic in Vietnam.

Speaker 1 Oh, wow. And now it's helping soldiers PTSD.
Isn't that ironic?

Speaker 4 I'm still not completely clear on what the definition of ironic is, but it's interesting anyway.

Speaker 4 It was great for battlefield medicine because it kicked in super fast and didn't suppress breathing like a lot of other anesthetics at the time did.

Speaker 4 Now, while it was in use on the battlefield, doctors noticed pretty quickly that it made people hallucinate. What they weren't expecting, though, was that it improved people's moods.

Speaker 4 And it wasn't until the 90s that people really started taking the mood elevation side effects seriously.

Speaker 1 Side effects. When did it move from the world of just study to people actually getting treatment? Basically, when was this use for ketamine approved, or is that not actually how it works?

Speaker 4 Yeah, it's still not approved. You can get ketamine inhalers, which is slightly different, but for the full-on treatment, that's what we call off-label use.

Speaker 4 Off-label use is when you take a drug not for its intended purpose, but for what you might call therapeutic side effects.

Speaker 1 And is that legal or?

Speaker 4 It's legal. Doctors can prescribe you stuff that works for your specific issues.
Even if the drug isn't designed to treat those issues, they're legally allowed to make that call.

Speaker 4 In fact, the off-label thing only applies to drug companies. They can't legally advertise their stuff for off-label use.
They can't sell ketamine and say it's going to make you feel great.

Speaker 1 Before we dive deeper into the K-hole, let's take a quick detour into the cash hole, where we'll attempt to dissociate you from your wallet. We'll be right back.

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Speaker 1 Okay, so the drug companies can't advertise it, but my Instagram feed can legally be full of people selling me ketamine treatment through the mail.

Speaker 1 That was like the episode we did on dick enhancement that came out a while back.

Speaker 1 But the only safe way to do that is hyaluronic acid filler, which is normally like a lip enhancement or something in your skin, on your face or something.

Speaker 1 But the off-label use just happens to supercharge a regular penis into a porn dick. Wait, what are we talking about again?

Speaker 4 Ketamine therapy. Mind out of the water, Jordan.

Speaker 1 I'm with you. I'm here.
All right.

Speaker 4 Anyway, as crazy as it sounds, yeah, that's right. The point is, yes, doctors can prescribe you things for reasons other than their officially intended purpose.

Speaker 4 The drug companies just can't advertise it to you that way. The big change for ketamine treatment took place in 2000 when some researchers at Yale, most notably Dr.
John Crystal and Dr.

Speaker 4 Dennis Charney, found that even a single low dose was highly effective at helping people with treatment-resistant depression.

Speaker 4 It was later found that it was also good for chronic pain, PTSD, and other issues.

Speaker 1 Why didn't this just revolutionize this field? I mean, why are people not going to the therapist and getting prescribed ketamine if they're having serious bouts of depression?

Speaker 4 I think the main reason is that ketamine is a Schedule III drug, which also includes heroin and cocaine. These are the most illegal of illegal drugs, the one you go to prison for.

Speaker 4 There's also the stigma against ketamine because of recreational use. But again, I just don't get how this is fun for anybody.

Speaker 1 Yeah, different strokes. So these guys at Yale discover what ketamine can do, a little bit of off-label use here and there, but now it seems like ketamine is everywhere, man.

Speaker 1 I get tons of ads for this stuff.

Speaker 3 It's insane.

Speaker 1 So how did a horse tranquilizer used by Rave Kids in the 90s become essentially like the new Xanax?

Speaker 4 The explosion happens after the FDA approves Bravado in 2019, which is a nasal form of S-ketamine, not ketamine, slightly different.

Speaker 4 S-ketamine is weirdly stronger, but doctors can give smaller doses because of that and mitigate the side effects.

Speaker 4 And a lot of doctors running ketamine treatment clinics are anesthesiologists, not psychiatrists. It makes good business sense for them.
These are, after all, for profit.

Speaker 4 They're not really for charity. I'm not aware of any that are.
I think mine was 500 bucks or so a session. So my intake week was about 2,500 bucks.
One session is just not going to cut it.

Speaker 4 And I can't imagine that anyone's insurance covers this.

Speaker 4 For what it's worth, that's a green flag for me because I tend to trust places that exist outside of the insurance system more than those that operate within it, but but your mileage may vary on this.

Speaker 4 More importantly, I think, is that the impression that ketamine is everywhere now is not just in people's heads. It's not selection bias based on seeing these ads everywhere.

Speaker 4 By 2015, there were 60 clinics coast to coast. By 2018, it was 300.
Now there's over 2,000. My little podunk town in Arizona had one for a minute.
The total market now is between 7 and 9 billion.

Speaker 4 Yes, that's billion with a B.

Speaker 1 That is crazy. That's way bigger than I would have thought.

Speaker 1 I remember before the reason I found my doctor, he happens to be in my town, but I found him through a friend that lives in like Iowa or something like that. I can't remember.

Speaker 1 He flew in from another state, and most of the other guys that I met there also flew in from another state. And now you can go to the place where your kid takes karate and just walk next door, right?

Speaker 1 The other side of the strip mall is a ketamine clinic. This has really exploded.
I'm curious about how this actually works. The majority of our audience, probably, of course, not doctors.

Speaker 1 So what is the smart person who doesn't know a lot about science version of how ketamine actually functions?

Speaker 1 Why does it work on people who don't see results from SSRIs or conventional antidepressants or conventional treatments for depression?

Speaker 4 Most traditional antidepressants are SSRIs. That's a selective serotonin reuptake inhibitor.
They basically increase the amount of serotonin in your brain.

Speaker 4 They don't create new pathways in your brain. They just try and flood the existing ones with serotonin.
That means they take weeks to kick in. And for a lot of people, they just don't work at all.

Speaker 1 Did you ever try SSRIs? Did you go down the road well-traveled with this antidepressant stuff?

Speaker 4 No, they scare the crap out of me because you have to wean off of them.

Speaker 4 And there's a whole phenomenon of a guy who's deeply suicidal, but he takes SSRIs and all of a sudden he has the pep he needs to eat a gun thanks to the increased serotonin, which I didn't want to be that guy.

Speaker 4 As usual, do whatever you and your doctor think is best. I am not saying they're bad.
I am definitely not saying people shouldn't use them if they're working. I'm just saying that for me, no thanks.

Speaker 1 Got it. So what is it that ketamine does differently?

Speaker 4 Ketamine causes a chain reaction with four steps that works completely different from SSRIs.

Speaker 4 First, it blocks your NDMA receptor, which is the receptor responsible for learning, memory, and mood regulation.

Speaker 1 Okay, so that doesn't sound like a good thing.

Speaker 4 It doesn't until you realize that this is going to cause your brain to surge in glutamate to compensate. That's going to speed up brain activity.

Speaker 4 Think of it like stepping on the gas of your brain function. It also enables learning and memory thanks to increased neuroplasticity, which is basically your brain's ability to make new connections.

Speaker 4 That's great.

Speaker 4 But what's maybe even better is that glutamate helps to balance your mood. The glutamate spike also increases your brain-derived neurotrophic factor or BDNF.

Speaker 4 The simplest way to envision this is miracle grow for your brain. All of this together leads to increased neuroplasticity.
So more or less your brain makes new connections and rewires old ones. Dr.

Speaker 4 John Crystal, chair of psychiatry at Yale, who I mentioned earlier, likens it to shaking up a snow globe.

Speaker 1 Snow globe? Was that what your experience was like?

Speaker 4 More or less. That's the thing.
It doesn't just pump happy chemicals into your brain. It just throws a puzzle on a floor and puts it back together in a totally different way.

Speaker 4 I used to tell people when I would go in for treatment that I was going to get my brain zapped.

Speaker 4 It's difficult to put it in words, but yeah, it shakes things up. A big part of how effective it's going to be, I think, is what you choose to do with that kind of reset.

Speaker 4 The reason why it's become so popular is because it's going going to work in hours rather than weeks or months.

Speaker 1 What about side effects? Did you experience any side effects during or after?

Speaker 4 Not that I remember, but as I mentioned earlier, I don't remember a lot about my treatments. I just used to put on my tunes and zone out.

Speaker 4 A lot of people don't like music with words when they receive their treatments, but I didn't have any issue with it.

Speaker 1 Do you have a go-to playlist for your ketamine treatments?

Speaker 4 Frank Zappa's apostrophe. One of my handlers at the end of my treatment says, Zappa fan, huh? And I go, how do you know that? And he said, you were singing about yellow snow.

Speaker 1 That's funny, which you don't remember.

Speaker 4 Don't remember any of it.

Speaker 1 That's funny.

Speaker 4 I know stuff happens when I'm bully dosed. I just don't remember it.
It's really impossible to communicate just how out of it you are.

Speaker 4 I don't remember any side effects, but they could include dizziness, nausea. hallucinations.

Speaker 4 I guess disassociation is a side effect, but I just think it's a thing that happens happens rather than a side effect, the way that people usually think about them.

Speaker 1 It's kind of the point. Like, it's only a side effect if you're trying to use it as anesthetic.
If you're not trying to use it to kill pain or whatever, tranquilize. Nope, that is what I want, right?

Speaker 1 I want dissociation.

Speaker 4 That's what's what we're here for. Yeah, exactly.

Speaker 1 What does the evidence say about the effectiveness of ketamine treatment? It sounds like it was pretty difficult for you at times, but it also sounds like you got a lot out of it, maybe.

Speaker 1 Anecdotally, look, I've known you for a long time. I can't believe how chilled out you are these days.

Speaker 1 I mean, the time periods periods between like, I won't say too much, but you're definitely like in a better place mentally, emotionally these days, I would say, by a lot, by a large margin.

Speaker 4 You're not the only person to notice this. I defer to those who know me best with regard to that.
But yeah, I mean, I definitely feel better.

Speaker 4 We only really have short-term tests at this point about the effectiveness of the treatments.

Speaker 4 But what they tell us is that ketamine treatments offer rapid relief, especially for suicidality, treatment-resistant depression. A lot of times ketamine treatment works when nothing else will.

Speaker 4 There have been some meta-analyses that show the effects are time-limited and require repeated dosing. That's what I mean about how it matters what you choose to do with your freshly scrambled brain.

Speaker 4 What we don't have are long-term studies. There's not much in the way of standardizing the dosing protocols.

Speaker 4 There's also no placebo-controlled blind studies, which I don't know how you would even do that.

Speaker 1 Yeah, I think people might notice whether or not they are tripping their face off in the fifth dimension. I don't know how you placebo that.

Speaker 4 Yeah, exactly. That's kind of a thing they can't really study.
I think the other thing to really highlight is that just because people are seeing results doesn't mean that it's a cure-all.

Speaker 4 It's probably going to be part of a broader treatment program as well as lifestyle changes.

Speaker 4 Some of the most promising work today is being done pairing ketamine therapy with traditional psychotherapy for trauma, but this is all still early days.

Speaker 4 I think it can be great and a real game changer for the right person. But what it is absolutely not is a magic potion that's going to fix all of your problems.

Speaker 1 It seems pretty clear that this has the potential to help a lot of people, but do you think it needs to be advertised as much as it is?

Speaker 1 I go entire weeks where half my ads are for these ketamine by mail therapy services.

Speaker 4 Yeah, and my phone's next to me right now, so I'm about to get a month's worth of ads for these places. I think there's a lot of problems with the through-the-mail thing.

Speaker 4 It's not a controlled environment. You don't have a handler.
The lozenges or pills probably aren't as effective as just sticking it into your blood supply.

Speaker 4 They may be better than nothing, but I definitely don't think it's ideal.

Speaker 4 I feel like it's an entirely different thing from what I did without a lot of evidence, just general sense of how this works from having gotten testosterone through these types of remote clinics.

Speaker 4 I suspect anyone with 300 bucks and a pulse qualifies for the treatment.

Speaker 1 Yeah, it strikes me as dangerous to be using ketamine without somebody nearby. A lot can go wrong physically or psychologically.

Speaker 1 And it seems like you should have someone there with you, like you said before, monitoring your vitals to make sure that you don't end up getting your brain deep fried instead of lightly scrambled or whatever you're supposed to be doing there or worse.

Speaker 4 Yeah, you can theoretically die from this. I'm not aware of anybody who has, but you can OD on ketamine.
It's definitely a not in the same way that you could OD on water. It's a tranquilizer.
So

Speaker 4 the other thing I think is the same thing we talked about on the TRT episode, which is episode 1172 for anybody playing at home.

Speaker 4 Some people might struggle with moderate depression that could be fixed with lifestyle changes, diet, exercise, and they're getting sold ketamine. To be clear, I am.

Speaker 4 Absolutely not telling everyone feeling depressed that they just need to work out and eat better. Obviously, that's not the case.

Speaker 4 If you haven't tried anything, start there and then go to the more extreme solutions if and when the simple ones fail. That would be a concern for me.

Speaker 1 Unlike chronic ketamine use, these ads won't destroy your bladder, though they might make it piss away a little cash. We'll be right back.

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Speaker 1 Now for the rest of Skeptical Sunday.

Speaker 1 You mentioned that this works for depression and PTSD and chronic pain, but as somebody who knows a thing or two about psychedelic drugs, I mean, I've known an acid casualty or three in my life.

Speaker 1 You know the type. Is there a type of person who ketamine is going to make go absolutely bonkers instead of healing them?

Speaker 4 Oh, 1,000%, yes. There are serious questions about the efficacy of ketamine therapy for people with schizophrenia.
personality disorders or bipolar disorder.

Speaker 4 There's some evidence to suggest that it's going to make them worse.

Speaker 1 Worse, how?

Speaker 4 So we talked about a couple different disorders that are very different from one another for schizophrenics and people with schizoaffective disorder. It can increase psychosis.

Speaker 4 In fact, ketamine is often used to model schizophrenic behavior in lab settings.

Speaker 1 So it sort of just puts a magnifying glass on the whole thing, which is not good.

Speaker 4 With people with bipolar disorder, it can put them in hypomanic episodes and give them insomnia, which is a big deal if you're in a hypomanic state, or increase their overall sense of grandiosity, their racing thoughts, their impulsive behavior.

Speaker 4 Like with the schizophrenics, it just seems to take their existing problem and make it worse.

Speaker 4 And personality disorders, like borderline personality disorder, ketamine can destabilize their entire personality and increase tendencies towards self-harm.

Speaker 4 Borderline personality disorder is extremely complex. The main thing to note is that people with BPD have a very weak sense of self.
They tend to change personalities a lot.

Speaker 4 And I don't mean they change styles or interest. Their entire personality changes sometimes multiple times in a day.

Speaker 4 Giving them something that depersonalizes them and weakens their sense of self causes many of them to panic and self-harm. Oof.

Speaker 4 Yeah, this is not a cure-all for every mental health problem people experience. It's for a few very specific problems and disorders.

Speaker 1 Anytime we talk about drugs, it's worth talking about dependence. So is there an addiction risk for ketamine? I've got a buddy who, according to him, he was addicted to ketamine.

Speaker 1 I don't know how to diagnose that. And then you hear rumors like Elon Musk is addicted to ketamine or whatever, right? Look at him.
Look at the ceiling. That means he's on ketamine.
I don't know.

Speaker 4 It's complicated. There's actually very few drugs that are addictive in the way that most people think of it.

Speaker 4 What you experience with ketamine is also true for a lot of non-addictive drugs, and that people form emotional and psychological dependence on them.

Speaker 4 There is some evidence that there is addiction at very high recreational doses taken very frequently, but not what you're going to get from your therapeutic structured dose at the clinic.

Speaker 4 Tolerance is definitely real. I built up a tolerance very quickly to the point where they were giving me the maximum safe dose for someone of my weight.

Speaker 1 So it's addictive in the same way that wheat or mushrooms are? It's just habit forming in some way?

Speaker 4 Yeah, it's a good way of thinking about it. Again, with the caveat that very high, very frequent dosing can actually be addictive.

Speaker 4 You're not typically going to get the shakes from stopping your ketamine dose. You might get irritated, bummed out, stuff like that.
Jonesing, you know, not withdrawal.

Speaker 4 It's not like getting addicted to crack and you're going to murder your mother for pocket change.

Speaker 1 Yeah, based on what you've told me about the overall experience, I think.

Speaker 1 If people are going to get addicted to ketamine, it's probably not going to be because they used it in a medically supervised setting for a specific purpose.

Speaker 1 Again, I've got a buddy who I know was addicted to it, but he was self-medicating his anxiety. He had a whole lot of untreated stuff, and he had trouble kicking the habit.

Speaker 1 He kind of thought, like, I'm better at life. He was a day trader and stuff.
And he's like, I'm better at trading and stuff when I'm on ketamine.

Speaker 1 As opposed to needing it to function, he added it as a recreational layer to his life. And I don't know if that distinction matters, but it was clearly unhealthy.

Speaker 4 Yeah, I'm going to again take the opportunity to express my bewilderment about why anyone would do this for recreational purposes, but I think it's way more likely that someone is going to form a dependency or habit based on sticking it up their nose at a rave than they are from laying in a clinic.

Speaker 1 What are some other dangers of ketamine therapy? I mean, you talked earlier about the potential emotional and psychological side effects. Is there anything more serious to be worried about?

Speaker 4 So apparently there's possible bladder and urological issues associated with frequent ketamine usage.

Speaker 1 Oh, you know what? Now that you mentioned that, I remember seeing signs at the doctor in Taiwan and in government buildings in Taiwan. It was people like holding their bladder.

Speaker 1 And I remember saying, what is this about? And someone explained to me that there's this super popular recreational drug that kids and teenagers are taking all the time.

Speaker 1 And they go out all the time and they take the stuff all the time and they snort it. They gave me the Chinese name and I looked it up and it was ketamine.
And I was like, oh, I had no idea that could.

Speaker 1 do anything to your bladder, but apparently people come in with these problems all the time in Taiwan. And they're like, hey, are you using ketamine? And they're like, maybe.
Yeah.

Speaker 1 Do you know anything about this?

Speaker 4 Ketamine used chronically at high recreational dosage can cause severe bladder damage. This is known as ketamine-induced cystitis.
This is apparently not a thing with clinical dosing.

Speaker 4 It's also very difficult to treat. So be careful if you're doing ketamine for fun.

Speaker 1 Yikes, that sounds terrible. I don't know what cystitis is, but yikes, bladder.

Speaker 4 I know I'm a 45-year-old man, and I can't sleep sleep through the night without getting up twice. So I ain't doing anything that's going to increase my trips to the bathroom.

Speaker 1 I need that thing functioning at peak performance or whatever the peak is at age 45. Exactly.

Speaker 4 There's also this phenomenon where people can get more depressed if the treatments don't work or they don't work as quickly as they want them to.

Speaker 4 There's also anecdotal evidence that people become more suicidal after short-term relief. But again, not well studied, not really anything you could call data.

Speaker 1 Do you think that there's a type of person who just uses ketamine therapy as an escape or a distraction rather than actually using it to solve their problems?

Speaker 4 Sure. Why not?

Speaker 1 So, isn't that a danger?

Speaker 4 I don't think so. First of all, as I think you and anyone who has listened to any of my previous episodes knows, like what adults do with their bodies is their business.
It's not mine.

Speaker 4 I also think that there's just such a low potential for addiction here. This isn't your local heroin clinic.

Speaker 4 We're talking about a drug that 100% 100% of the people on this podcast find unpleasant, and it's also pretty expensive.

Speaker 1 Yeah, but there is potential for addiction.

Speaker 4 Yeah, but again, it's recreational use at high doses. I think a lot of people might be self-medicating and they're more the ones you should be worried about rather than people in treatment facilities.

Speaker 4 So

Speaker 4 are people misusing ketamine therapy? Probably, but I just don't see any scenario where this is in the top 1,000 problems in America today.

Speaker 1 Could this be a kind of gateway for other psychedelic drugs to be used in therapy? Maybe there are other options people can use that we should be exploring.

Speaker 4 I think it's entirely possible. And if that helps people, great.
I really hate what the weed industry has become in this country, but... This doesn't seem to be the beginning of that.

Speaker 4 We're not seeing ketamine dispensaries popping up across the street from middle schools.

Speaker 1 Yeah, the by mail thing. But again, that's supposed to be therapeutic.
Who knows? But medicalization of marijuana is what preceded its legalization for recreational purposes as well.

Speaker 1 So I haven't looked at this closely, but I don't know if I see a huge difference here.

Speaker 4 Sure. I think that there are some key differences here, though.
First of all, ketamine is a hardcore drug.

Speaker 4 The weed on the market today is definitely a different beast than what people were smoking in the 60s and 70s. But even then, I just, I don't really see it as comparable.

Speaker 4 You might be looking at some kind of chain reaction where we get medical mushrooms and medical molly, and

Speaker 4 those could be moved from medical use to recreational use. But

Speaker 4 at this point, we've gamed this out like three steps ahead.

Speaker 1 Yeah, fair point. I think the bigger thing that's a threat right now is people who don't really need it getting it through the mail without proper vetting.

Speaker 1 I know there has to be at least one person out there who is wondering if ketamine therapy is right for them.

Speaker 1 And I suspect they're probably not going to want to be doing pills by mail or going to some shady fly-by-night clinic in a strip strip mall.

Speaker 1 What are those people going to want to look for in terms of a safe place to get treatment for this by somebody who's qualified?

Speaker 4 First, you're going to want to get a full psyche bowel, some kind of health check during intake.

Speaker 4 You're probably also going to want to talk to your therapist if you have one, and you want to go to a place that's looking to screen out inappropriate candidates.

Speaker 1 Okay, what about red flags? What are some things that should have people walking straight out the door as soon as they see it?

Speaker 4 Boy, I don't know, man. I don't want to get you in trouble with your potential sponsors.

Speaker 1 Well, don't worry. I don't think I would entertain a sponsor that did telehealth ketamine just because of, look, I got other sponsors coming in.
Genes,

Speaker 1 no problem. Some software, no problem.
And you know what? Let's not worry about pissing off any sponsors. I think if we find something negative about a sponsor, I also want to know about it.

Speaker 1 People email me about this all the time.

Speaker 4 For reasons I've mentioned, I just don't think these distance clinics are the right approach. Beyond that, the treatment is being touted as some kind of spa or self-improvement or optimization.

Speaker 4 That's not what this is about. Whoever you're seeing should hopefully have some kind of mental health professional on staff.

Speaker 4 In addition, vague promises in general are bad, no matter what you're trying to buy, but especially when we're talking about horse tranquilizers.

Speaker 4 Remember, ketamine exists to treat a limited set of very specific mental health issues. It is not vaguely about healing trauma or, God forbid, enhancing consciousness.

Speaker 1 Yeah, definitely good advice all around. Remember, guys, this is medicine, not a way to trip your face off legally.
It's also a big business where, as Nick said, the purpose is to make money.

Speaker 1 There's a huge difference between evidence-based treatment and selling an altered state to people desperate for any kind of solution. Follow the data, not the dopamine rush.

Speaker 1 If you're interested in this and you think it'll help you, the first place to start is probably by talking to your therapist. And if you don't have one, you should start by getting one.

Speaker 1 After that, make sure that you talk to a real medical doctor, which neither Nick or I happen to be. And this is by no means any kind of medical advice, as always.

Speaker 1 Thanks to Nick for guiding us down this K-hole. Also, special thanks to Dr.
Matt Cook.

Speaker 1 out in Campbell, California for his expertise on this episode, helping us fact-check this, make sure we weren't talking out of the wrong end. A link to his clinic will be in the show notes as well.

Speaker 1 And thanks to you for listening. Topic suggestions for future episodes of Skeptical Sunday to me, Jordan at JordanHarbinger.com.

Speaker 1 Advertisers, deals, discounts, ways to support the show, all at jordanharbinger.com slash deals. I'm at Jordan Harbinger on Twitter and Instagram.
You can also connect with me on LinkedIn.

Speaker 1 And this show is created in association with Podcast One. My team is Jen Harbinger, Jace Sanderson, Tata Sedlowskis, Robert Fogarty, Ian Baird, and Gabriel Mizrahi.

Speaker 1 Our advice and opinions are our own. And yes, I am a lawyer, but I'm not your lawyer.
Of course, we try to get these as right as we can. Not everything is gospel, even if it is fact-checked.

Speaker 1 So consult a professional before applying anything you hear on the show, especially if it's about your health and well-being. Remember, we rise by lifting others.
Share the show with those you love.

Speaker 1 If you found the episode useful, please share it with somebody else who could use a good dose of the skepticism and knowledge we doled out today.

Speaker 1 In the meantime, I hope you apply what you hear on the show so you can live what you learn. And we'll see you next time.

Speaker 1 Ever find yourself trapped in a cycle of always wanting more and never feeling content?

Speaker 1 You're about to hear a preview of the the Jordan Harbinger Show where scare city brain author Michael Easter unravels the mysteries of our primal drives and how they can be both our downfall and our salvation.

Speaker 5 I'm an investigative journalist, but I firmly believe that to understand a story, to understand all the mechanics of it, to get the information that you need to really tell a story, you have to go in person.

Speaker 5 Sometimes I get to go to the nice, shiny, comfortable labs where they bring me coffee and it's, you know, at Harvard or whatever.

Speaker 5 But some days you find yourself in Iraq in a prison looking at cells of drug dealers and terrorists.

Speaker 5 But ultimately, I think that going there makes you get a better story, makes the story more interesting and gets you better information to really understand it.

Speaker 5 Everyone knows that everything is fine in moderation. So then the question is, well, why do we all suck so bad at it? People keep eating when they're full.

Speaker 5 We often find ourselves shopping when we already own a ton of stuff. We scroll through social media or keep binging news when we know it's not necessarily improving our mental health.

Speaker 5 When you think about how humans evolved, everything we needed to survive in the past, it was all scarce and it was all hard to find, right?

Speaker 5 So everything from food to possessions to information, even influence and status, the number of people we could influence.

Speaker 1 All hard to find, all scarce.

Speaker 5 And we lived like that for basically two and a half million years.

Speaker 5 And it wasn't until very recently in the grand scheme of time that we started to get abundance of all these things that were sort of built to crave.

Speaker 5 So in the past, it always made sense to eat more food than you needed if you had the opportunity, to hoard items, to try and get as much information as you can, just keep keep seeking information.

Speaker 5 All that would give you a survival advantage. And then our environment split, and now we have an abundance of all this stuff, and we're still compelled to just consume and consume all this stuff.

Speaker 1 For more about our insatiable desires and how to harness them for good, tune in to episode 902.